Are Statins an Excuse for Unhealthy Eating?

Twenty-five-year-old Brittney Lipsett has had high cholesterol since she was 13 years old. Her parents, aunts and uncles on both sides of family take statins to control their high cholesterol, and about a year and a half ago, Lipsett decided to join them and go on a statin too.

Previously, Lipsett had tried to lower her cholesterol through diet.

"I tried to do the diet," said Lipsett, a marketing coordinator from New Haven, Conn. "I ate all organic. It did help me a little bit. My LDL [the bad cholesterol] went down to the 220 range, but then I found out I was allergic to wheat and gluten, and I couldn't just eat vegetables and fish all day."

When her numbers climbed up again, she started on a statin. And it worked. "My most recent tests show my lowest numbers ever, at 205," she said.

But as her cholesterol dropped, so too did her healthy lifestyle.

"Since then, I haven't exercised or been watching my diet.

"I tend to go for foods such as meat or shellfish that are very high in cholesterol," said Lipsett. "I love to eat, so it makes it difficult."

Health, United States, 2010

While throwing dietary caution to the wind, Lipsett joined the millions of Americans who also take statins for high cholesterol, and Wednesday, the Centers for Disease Control and Prevention published its 34th annual report titled "Health, United States, 2010." The CDC found that adults age 45 and older increased their statin use 10-fold, from 2 percent between 1988 and 1994, to 25 percent between 2005 and 2008.

And, with news that pleased many heart doctors, deaths associated with heart disease declined by 28 percent from 1999 to 2007.

"The positive news is that there is a big benefit of taking the statins as has been seen with the mortality data," said Dr. Christopher Cannon, a professor of medicine at Brigham and Women's Hospital.
"It's a huge win.

"Of note, the U.K. announced a few months ago a significant reduction in mortality rates that was linked to better use of cardiovascular medications, including statins," said Cannon.

High cholesterol is a risk factor for heart disease, and doctors often suggest using such cholesterol-lowering medications as Lipitor and Crestor. As many as 48 million U.S. adults have high levels of LDL, or bad cholesterol.

Healthy with High Cholesterol

But contrary to popular belief, healthy, young people can have high cholesterol, alongside those who are overweight and older.

"It's very common to see healthy people with high cholesterol," said Cannon.

Many believe that putting people on statins helps them stay healthy. But how bad is it when these people believe their new, low cholesterol levels are an invitation to eat unhealthy food?

Despite general health guidelines, doctors say it's OK to cheat once in a while when taking a statin for high cholesterol.

"It's probably way better to be eating one extra steak a week than not to take the statin," said Cannon. "I often recommend moderation, and there's probably more benefit than harm that you might be able to cheat a little more [on a statin]."

Cannon said that while the desire to eat "badly" comes from many different messages in the culture, it is a misconception to believe that every person can lower his or her cholesterol just by exercising and eating right. There is a heavy genetic component to high cholesterol, and no matter how fit, some people can't escape their genes.

But one of Cannon's patients, Gerald Thornell, said he tries to be ever mindful of his lifestyle after suffering a mild heart attack in 2004.

"You really have to take a good look at your diet and make some modifications," said Thornell, an education professor at Bridgewater State University in Bridgewater, Mass. "It's ludicrous to think that you have a magic pill and you continue to do whatever the hell you want to do."

Dr. Harlan Krumholz, a professor of medicine, epidemiology and public health at Yale University School of Medicine, said that it is a doctor's job to guide patients toward a diet that makes sense and is balanced.

"I don't want patients to feel that they are on a deprivation diet that does not allow them an occasional splurge, or a nice meal that they can enjoy," said Krumholz. "If we make recommendations that people cannot follow, then they will simply nod their heads during the office visit and then go in a different direction or feel guilty that they are not living up to expectations."

A Sweet Tooth is OK, Once in a While

Despite mindful changes, Thornell said he still gives into his sweet tooth once in a while.

"During the holidays and Valentine's Day, a few more chocolates go through my hands than they should, but I have maintained my weight," said Thornell.

"Statins, when used appropriately, are very safe and effective for reducing heart attacks and other heart and blood vessel problems in a wide range of individuals," said Dr. James Stein, director of preventive cardiology at University of Wisconsin-Madison. "Since heart disease still is the leading cause of morbidity and mortality in the U.S., I personally think they are underused and am surprised more people are not taking them."

Cholesterol Drops Like a Stone

Thornell said that, after going on a statin, his LDL, or bad cholesterol, "dropped like a stone" from around 160 to 37.

Krumholz said that the CDC report signaled a marked change in medical practices, and may explain some of the recent declines in hospitalizations for heart attacks and heart failure.

"The evidence that statins can reduce risk, at any level of cholesterol is strong, and the use of statins by patients with a high risk is an effective strategy to avoid future heart disease," said Krumholz. "In our enthusiasm about this strategy, however, we should be sure that those with a low risk of heart disease understand that they have little to gain by taking the medication."

"What is important is that we ensure that the drugs are used by those most likely to benefit," continued Krumholz. "We cannot lose focus on the value of healthy lifestyles can also play in promoting heart health."

"Once your safety net is broken, you're reluctant to leave it broken," said Thornell, referring to his mild heart attack and high cholesterol days. "If you're careful and create a diet and exercise program, the statin helps make a nice triangle, and that's about the best you can do."